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Review
. 2015 Nov 24;85(21):1843-51.
doi: 10.1212/WNL.0000000000002145. Epub 2015 Oct 30.

Cognitive training in Parkinson disease: A systematic review and meta-analysis

Isabella H K Leung  1 , Courtney C Walton  1 , Harry Hallock  1 , Simon J G Lewis  1 , Michael Valenzuela  1 , Amit Lampit  2
Affiliations
Review

Cognitive training in Parkinson disease: A systematic review and meta-analysis

Isabella H K Leung et al. Neurology. .

Abstract

Objective: To quantify the effects of cognitive training (CT) on cognitive and behavioral outcome measures in patients with Parkinson disease (PD).

Methods: We systematically searched 5 databases for randomized controlled trials (RCTs) of CT in patients with PD reporting cognitive or behavioral outcomes. Efficacy was measured as standardized mean difference (Hedges g) of post-training change.

Results: Seven studies encompassing 272 patients with Hoehn & Yahr Stages 1-3 were included. The overall effect of CT over and above control conditions was small but statistically significant (7 studies: g = 0.23, 95% confidence interval [CI] 0.014-0.44, p = 0.037). True heterogeneity across studies was low (I(2) = 0%) and there was no evidence of publication bias. Larger effect sizes were noted on working memory (4 studies: g = 0.74, CI 0.32-1.17, p = 0.001), processing speed (4 studies: g = 0.31, CI 0.01-0.61, p = 0.04), and executive function (5 studies: g = 0.30, CI 0.01-0.58, p = 0.042), while effects on measures of global cognition (4 studies), memory (5 studies), visuospatial skills (4 studies), and depression (5 studies), as well as attention, quality of life, and instrumental activities of daily living (3 studies each), were not statistically significant. No adverse events were reported.

Conclusions: Though still small, the current body of RCT evidence indicates that CT is safe and modestly effective on cognition in patients with mild to moderate PD. Larger RCTs are necessary to examine the utility of CT for secondary prevention of cognitive decline in this population.

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Figures

Figure 1
Figure 1. Summary of trial identification and selection
Note that a single study could be excluded on more than one criterion, but appears only once in the chart. RCT = randomized controlled trial.
Figure 2
Figure 2. Overall efficacy of cognitive training on all cognitive outcomes
Effect estimates are based on a random-effects model. CI = confidence interval; CT = cognitive training.
Figure 3
Figure 3. Efficacy of cognitive training on measures of executive function, processing speed, working memory, and global cognition
Effect estimates are based on a random-effects model. CI = confidence interval; CT = cognitive training.
Figure 4
Figure 4. Efficacy of cognitive training on measures of attention, memory, visuospatial skills, and depression
Effect estimates are based on a random-effects model. CI = confidence interval; CT = cognitive training.
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